Bear the Children Flashcards
1
Q
What can cause a false VDRL positive?
A
Antiphospholipid Antibody Syndrome
2
Q
Young pregnant patient with previous miscarriages, positive VDRL & negative FTA-ABS
A
Previous miscarriages make you think Lupus
Negative FTA-ABS makes syphilis much less likely
The VDRL positive could be from Antiphospholipid
Common findings include clots, thrombocytopenia & prolonged aPTT.
Start on LMWH to reduce risk to current pregnancy
3
Q
Timeline of Postpartum Blues
A
Onset of 2 - 3 days postpartum
Resolves within 2 weeks
Treatment: Reassurance
4
Q
Timeline of Postpartum Depression
A
Onset typically 4 - 6 weeks postpartum (but can start anytime within the first year)
Lasts longer than 2 weeks
Treat with SSRIs and/or psychotherapy
5
Q
Which SSRI is preferred in postpartum depression?
A
Sertraline (infant serum levels are undetectable, even with breastfeeding)
6
Q
Hyperandrogenism during pregnancy is caused by
A
Ovarian masses
Luteoma
Theca Luteum Cyst
Krukenberg Tumor
7
Q
African American pregnant patient with new-onset hirsutism & acne
A
Luteoma
Yellow or yellow-brown mass (often with areas of hemorrhage) of large lutein cells
Appears as solid ovarian mass (bilateral in half patients)
Benign
Puts female fetus at high risk of virilization
8
Q
Treatment of Luteoma
A
Clinical monitoring (w/ ultrasound) Mass effect (hydronephrosis, obstructive labor, ovarian torsion) rare but nonzero risk. Surgery if so. Symptoms regress spontaneously after delivery
9
Q
New onset solid ovarian mass in pregnancy
A
Luteoma
OR
Krukenberg Tumor
10
Q
Krukenberg Tumor
A
Metastasis from primary GI cancer
Should present with other oncologic symptoms (weight loss, abdominal pain, etc)
Solid ovarian mass on ultrasound
Presents with hyperandrogenism
Female fetus at high risk of virilization
Biopsy & surgery indicated if malignancy is suspected
11
Q
New onset multi-sepatated ovarian mass in pregnancy
A
Theca Lutein Cyst
Can be asymptomatic or cause hyperandrogenism (less likely)
Arises from high beta-hCG levels (molar or multip)
If complete hydatidiform mole, suction curettage
Theca Lutein Cyst will regress spontaneously
12
Q
On TVUS:
Central heterogeneous mass
Numerous discrete anechoic spaces
A
Complete Hydatidiform Mole
13
Q
Hyperemesis gravidarum
Bilaterally enlarged ovaries
A
Concerning for complete hydatidiform mole
14
Q
How does a complete hydatidiform mole form?
A
Abnormal fertilization of empty ovum by 2 sperm
OR
Fertilization by 1 sperm that duplicates its genome
Leads to crazy high beta-hCG
Leads to hyperstimulation of ovaries and Theca Lutein Cysts
15
Q
Main risk side effect of epidural anesthesia
A
Hypotension (occurs in 10% of epidurals)
Sympathetic nerves responsible for vascular tone are blocked
Vasodilation ensues, which can lead to venous pooling & hypotension
Complication can be fetal acidosis from hypoperfusion
Prevent with aggressive IV fluid volume expansion beforehand
Treat by placing mom on her Left side, give IV fluids and/or pressors
16
Q
Rare side effect of epidural anesthesia in a high spinal or a total spinal
A
Depression of cervical spinal cord & brainstem activity
First signs:
Hypotension
Bradycardia
Respiratory difficulty
Late signs:
Diaphragmatic paralysis
Cardiopulmonary arrest
17
Q
Pregnant patient receives epidural during delivery
Develops postural headache postpartum (worse sitting up, better lying down)
A
Dura was inadvertently punctured (“wet tap”)
Spinal fluid is leaking out
18
Q
Definition of PPROM
A
Rupture of membranes < 37w
Some patients experience gush
Others experience intermittent leakage
19
Q
Nitrazine-Positive
A
It is amniotic fluid, not urine
20
Q
PPROM at >= 34w
A
Deliver
M&M associated with premature delivery decreases at 34w
Chorioamnionitis is bad news
Give intrapartum IV Penicillin if GBS status is unknown
21
Q
PPROM at < 34w w/ signs of infection (maternal fever, fetal tachycardia) or fetal compromise
A
Deliver
22
Q
First line therapy for stress incontinence in pregnancy
A
Kegels
Pessary
23
Q
Elevated Maternal Serum AFP at 15 - 20 weeks
A
Open neural tube defects:
Anencephaly
Open spina bifida
Ventral wall defects:
Omphalocele
Gastroschisis
Multiple gestation
Rare:
Fetal congenital nephrosis
Benign obstructive uropathy
24
Q
Decreased Maternal Serum AFP at 15 - 20 weeks
A
Aneuploidies:
Trisomy 18
Trisomy 21
25
Diagnosis of CF
Genetic testing of parents
If both parents are carriers:
CVS, Amniocentesis or fetal blood sampling can confirm
AFP is not affected
26
Maternal causes of elevated AFP
Hepatocellular Carcinoma
Gonadal Tumors
Liver Disease (Acute or chronic viral hepatitis)
Only suspect these if mom is symptomatic
27
What causes Trisomy 18?
Meiotic Nondisjunction (usually)
28
What causes Trisomy 21?
Meiotic Nondisjunction or Robertsonian Translocation
29
Low Maternal Serum AFP
Low estriol
High beta-hCG
High Inhibin A
Trisomy 21
| Down Syndrome
30
Low Maternal Serum AFP
Very Low Estriol
Very Low beta-hCG
Normal Inhibin A
Trisomy 18
31
Asymmetric Moro Reflex
Pain with passive motion of affected extremity
Crepitus over affected clavicle
Displaced clavicular fracture
Heals spontaneously in 7 - 10 days w/o sequelae
Treatment = reassurance & guidance on gentle handling
Pinning infant's sleeve to shirt can reduce motion and decrease pain
32
Why do we avoid Aspirin in infants?
To avoid Reye syndrome
33
Nonblanching blue-grey patches
Mongolian Spots
| Benign, common in dark-skinned infants
34
Routine Prenatal Labs - Initial Visit
```
Rh (D) type, Ab screen
H&H / MCV
HIV, VDRL/RPR, HbSAg
Rubella & Varicella Titers
Pap (if screening indicated)
Chlamydia PCR
UCx
Urine Protein
```
HbA1C or OGTT if mom is at risk for undiagnosed DMII
35
Routine Prenatal Labs - 24 - 28 weeks
H&H
Ab Screen (if Rh Neg)
50g 1h GCT
Repeat HbSAg & Chlamydia PCR if mom is high risk (IVDU, STIs earlier in pregnancy)
36
Routine Prenatal labs - 35 - 37 weeks
GBS Cx
37
Risk factors for gestational diabetes
Obesity
Excessive weight gain during pregnancy
Family history of DM
Previous macrosomic infant
38
When do we give Rhogam?
```
28 - 32w normal gestation
<72h after delivery of Rh+ infant
<72h after Spontaneous Abortion
Ectopic pregnancy
Threatened abortion
Hydatidiform mole
CVS, Amniocentesis
Abdominal trauma
2nd & 3rd trimester bleeding
External cephalic version
```
Any occasion for mom to be exposed to fetal blood
39
Rh(-) mom is sensitized and has elevated Ab titers already. Do we give Rhogam anyway?
No. Just monitor fetus closely for hemolytic disease.
40
Potential maternal complication of fetal demise
Coagulopathy after several weeks of fetal retention
41
Fetal ASD in AMA mom is associated with
Trisomy 21
42
Symmetric fetal growth restriction occurs when?
First trimester
Due to aneuploidy, congenital abnormalities or infection
43
Asymmetric fetal growth restriction occurs when?
Second & third trimesters
Due to maternal conditions leading to placental insufficiency, such as hypertension
44
Patient with placenta previa is at risk for
Painless but severe antepartum hemorrhage
45
Guidelines for managing placenta previa
May resolve on its own as lower uterine segment grows
Pelvic rest & abstinence from intercourse are recommended.
Clinicians should refrain from digital examination of the cervix
Vaginal delivery is contraindicated
Cesarean delivery is scheduled for 36 - 37 weeks to avoid exposing patient to labor contractions
46
Indications for cerclage
```
History of second-trimester deliveries
Short cervix (<2.5cm)
```
47
If placenta previa resolves on its own, what is the patient still at risk for?
Vasa previa
Evaluate with doppler (weekly is not necessary)
48
Risk factors for postpartum urinary retention
```
Nulliparity
Prolonged labor
Instrumental delivery
Regional anesthesia (reduces sensory & motor impulses from sacral spinal cord, leads to bladder atony)
Perineal trauma (pudendal nerve palsy & perineal edema can lead to urinary retention)
```
49
When to suspect postpartum urinary retention
Patient is unable to void 6 hours after vaginal delivery
OR
Patient is unable to void 6 hours after removal of catheter for cesarean.
50
How to confirm postpartum urinary retention
Urethral catheterization more accurate than bladder scan
Confirms retention at >= 150mL urine
51
Treatment of postpartum urinary retention
Analgesia
Ambulation
If those don't work, catheterize & reassure that retention is usually temporary and reversible
52
Postpartum decreased urine production
Postpartum hemorrhage can lead to renal hypoperfusion & ATN
OR
Preeclampsia can cause intense vasospasm & third spacing
53
Breast Engorgement
Onset 3 - 5 days postpartum
Occurs any time there is milk accumulating
Bilateral symmetric breast fullness, tenderness, warmth
No fever
54
Treatment of breast engorgement
Cold compresses
Acetaminophen
NSAIDS
Regular breastfeeding or pumping
55
Risk factors for abruptio placentae
Hypertension
Cocaine use
Maternal trauma
56
Abdominal and/or back pain late in pregnancy
Category 2 or 3 tracing
Vaginal bleeding
Abruptio placentae
May present with firm uterus, uterine distension (if bleeding is concealed) and low-amplitude frequent contractions
57
How often should BPPs be performed in gestational hypertension?
Weekly
58
BPP reveals 6/10
Equivocal
| Repeat in 24 hours
59
Definition of Small for Gestational Age
Weight < 10th percentile for gestational age
60
Maternal factors leading to SGA infants
```
Preeclampsia
Malnutrition
Placental Insufficiency
Multiparity
Drug Use
```
61
Fetal factors leading to SGA infants
Genetic Factors
Chromosomal Abnormalities
Congenital Infections
Inborn Errors of Metabolism
62
SGA infants are at risk for
```
Hypoxia
Perinatal Asphyxia
Meconium Aspiration
Hypothermia
Hypoglycemia
Hypocalcemia
Polycythemia (a response to hypoxia)
```
63
When is it classified as Gestational Hypertension?
>=140 / >= 90 on 2 separate measurements at least 4h apart
New at >= 20w gestation (anything earlier is chronic)
AND
Proteinuria OR signs of end organ damage
64
Maternal pregnancy risks from hypertension
```
Superimposed Preeclampsia
Postpartum Hemorrhage
Gestational Diabetes
Abruptio Placentae
Cesarean Delivery
```
65
Fetal risks from maternal hypertension
Fetal growth restriction
Perinatal mortality
Preterm delviery
Oligohydramnios
66
Acute Fatty Liver of Pregnancy
Nausea
Vomiting
Abdominal Pain
Jaundice
67
In a patient with preeclampsia bordering on hypertensive emergency, what anithypertensives would you use?
IV Hydralazine
IV Labetalol (if patient is not bradycardic)
PO Nifedipine
68
When do you give the quadruple screen?
Weeks 15 - 22
AFP
Estriol
beta-hCG
Inhibin A
69
When do you offer cell free fetal DNA testing?
> = 10 weeks
Not diagnostic, but highly sensitive & specific
70
When do you offer CVS?
Weeks 10 - 13
71
When do you offer amniocentesis?
Weeks 15 - 20
72
Endometriosis discovered incidentally with no symptoms
Observation only for now
73
Treatment of Uterine Inversion
IV Fluid Replacement
Manual replacement of the uterus
Placental removal & uterotonic drugs (oxytocin, misoprostol)
74
First stage of labor
From onset of regular contractions
To when patient is 10cm dilated
Contains latent phase (gradual dilation) & active phase (rapid dilation)
75
No cervical change for >= 4 hours with adequate contractions
OR
No cervical change for >= 6 hours with inadequate contractions
Arrest of Labor
Perform cesarean delivery
76
```
PPROM
Maternal Fever
Maternal & Fetal Tachycardia
Uterine Fundal Tenderness
Maternal Leukocytosis
```
Chorioamnionitis
77
If the fetus shows signs of infection during delivery
Give broad spectrum antibiotics and induce
Only perform cesarean for standard indications (fetal heart tracing, breech, prior surgeries)
78
Patient displays heart failure signs in pregnancy, but is overall stable
Reassure
79
Biggest risk factor for preterm labor
Previous preterm delivery
80
```
At Delivery:
Thin, loose skin
Thin umbilical cord
Wide anterior fontanel
Meconium-stained amniotic fluid
Decreased subQ fat
```
Fetal Growth Restriction
Send placenta for histopathologic exam, looking for:
Infarction
Infection (especially spirochetes)
Send UTox & Serology, looking for:
Drugs
Infection (especially CMV, Toxo, Rubella)
If Physical Exam is syndromic, send karytoype
81
Indications for cranial ultrasonography
Gestaional age < 30w at delivery
Respiratory distress
Hypotension
82
Indications for antibiotics in the newborn
Fever
Tachypnea
Grunting
Lethargy
83
Meconium Aspiration Syndrome
Respiratory distress due to inhalation of meconium-stained amniotic fluid
Give surfactant therapy
84
Painless vaginal bleeding
| Fetal heart rate abnormalities after amniotomy
Vasa Previa
85
First trimester lithium use is associated with
Increased risk of congenital heart disease
Especially Ebstein's anomaly
If bipolar disease is stable, consider slow taper
86
Congenital abnormalities associated with Isotretinoin
Carniofacial Dysmorphism
Heart defects
Deafness
87
Woman of reproductive age wants to start isotretinoin. What are the requirements?
Two effective forms of contraception have been used for at least 1 month prior to initiation
88
Pathophys of Osteogenesis Imperfecta
Autosomal Dominant
| Type 1 Collagen Defect
89
Findings in Osteogenesis Imperfecta Type II
```
Multiple fractures
Short femur
Hypoplastic thoracic cavity
Fetal growth restriction
Intrauterine demise
```
90
Types of Osteogenesis Imperfecta
Mild (Type I)
Fatal Perinatal (Type II)
Moderate (Types III - IX)
91
If a fetus with Osteogenesis Imperfecta Type II survives delivery, how does it die?
Pulmonary hypolpasia (complication of hypoplastic thoracic cavity)
Give supportive care while fetus remains alive
92
Achondroplasia
Non-lethal
Autosomal Dominant
Bone dysplasia
93
Features of Achondroplasia
```
Macrocephaly
Frontal Bossing
Midface Hypoplasia
Genu Varum
Limb Shortening
```
94
Limb Defects
Craniofacial Defects
Abdominal Wall Defects
Amniotic Band Sequence
95
Paget Disease of the Bone
Bone metabolism disorder
Defective osteoclasts
Adult onset
Headaches, hearing loss, spinal stenosis, osteosarcoma
96
Potter Sequence
Pulmonary Hypoplasia
Limb Deformities
Oligohydramnios
Most commonly due to Urinary Tract Abnormalities (Bilateral renal agenesis, polycystic kidney disease)
97
Maternal Vitamin D Deficiency is associated with
Fetal Growth Restriction
98
Risk factors for placenta accreta
History of cesarean
History of D&C
AMA
99
First 6 months of the Depot Medroxyprogesterone injection method of contraception
Menstrual irregularities
100
1 year of use of the Depot Medroxyprogesterone injection method of contraception
50% of women have amenorrhea at this point
101
Rare side effects of the Depot Medroxyprogesterone injection method of contraception
Weight Gain
Fatigue
Nausea
Breast Tenderness
These symptoms are typically experienced throughout. If they are new, after the injections have been going on for a while, consider pregnancy
102
Decreased fetal movements
Suspect fetal compromise
Proceed to NST
103
When do you do routine NSTs?
High-risk pregnancies starting at 32 - 34 weeks
Or if mom feels less fetal movement
104
Normal NST looks like
In 20 min there are >= 2 accelerations of at least 15 bpm above baseline, lasting 15 seconds each
105
Most common cause of abnormal NST
Fetal sleep cycle
Awaken fetus with vibroacoustic stimulation
106
Causes of uterine atony
Fatigue (Prolonged labor)
Overdistended (Fetal weight > 8.8 lbs)
Unresponsive to oxytocin from receptor saturation
107
Risk factors for uterine atony
Operative vaginal delivery
| Hypertensive disorders
108
In pregnancy, DIC is associated with
Preeclampsia
Amniotic Fluid Embolism
Sepsis
109
Most common cause of primary postpartum hemorrhage
Uterine Atony
110
First line management of postpartum hemorrhage
Bimanual massage
| Oxytocin (IV)
111
If Oxytocin & massage fail to resolve postpartum hemorrhage, proceed to
Methylergonovine (avoid in HTN)
| Carboprost (avoid in asthma)
112
Normal Postpartum Findings
```
Transient rigors/chills
Peripheral edema
Lochia rubra
Uterine contraction & involution
Breast engorgement
```
113
Routine Postpartum Care
```
Rooming-in / Lactation support
Serial examination for uterine atony/bleeding
Perineal care
Voiding trial
Pain management
```
114
Components of Apgar score
```
Muscular tone (2)
Respiratory effort (2)
Heart rate (2)
Reflex irritability (2)
Pink body color (2)
```
115
Checklist for normal baby immediately after birth
Clear airway secretions (suction)
Dry infant & keep warm
Erythromycin to the eyes
Vitamin K IM
116
Amphetamine use during pregnancy is associated with
Preterm delivery
Abruptio placentae
Fetal growth restriction
Intrauterine fetal demise
117
Management of pubic symphysis diastasis
Supportive care (pelvic support, PT)
Most patients recover within 4 weeks
118
Risk of McRoberts Maneuver
Femoral nerve damage
119
When is GBS screening most appropriate
3 - 5 weeks prior to delviery
Without signs of preterm labor, most screening is done at 35 - 37 weeks gestation
120
Elevated fetal fibronectin < 20w gestation
Normal
121
Elevated fetal fibronectin > 20w gestation
Sign of imminent labor. If it is term, whoopee!!
If it is preterm, fetus is at risk for preterm delivery.
122
Pregnant patient has history of preterm delivery
At risk for another
Give IM progesterone starting in 2nd trimester
Serial TVUS to assess cervical lengths
If short cervix, cerclage
123
Agent for ripening cervix
Prostaglandins
124
When do we give medical induction for a spontaneous abortion (missed or inevitable)?
When the patient is hemodynamically stable
125
How is Gabapentin excreted?
Renally
In pregnancy, the kidneys are working harder and dose adjustments may be necessary to maintain serum levels
126
Mechanism of hypercoagulability in pregnancy
Decreased Protein S activity
Increased Fibrinogen
Increased resistance to Activated Protein C
127
Risk factors for Hyperemesis Gravidarium
Multiple Gestations
Hydatidiform Mole
History of GERD
128
How do you differentiate typical nausea/vomiting of pregnancy from Hyperemesis Gravidarium
Ketones on urinalysis = HG
Volume Status Changes = HG
Weight loss of > 5% prepregnancy weight
129
Treatment of Hyperemesis Gravidarium
Hospital admission
IV Antiemetics
IV Fluids
130
Recommended vaccines during pregnancy
Tdap
Inactivated influenza
RhoGAM
131
Vaccines for high risk patients in pregnancy
```
Hepatitis B
Hepatitis A
Penumococcus
H. Flu
Meningococcus
Varicella-zoster immunoglobulin
```
132
Vaccines contraindicated in pregnancy
HPV
MMR
Live-attenuated influenza
Varicella
133
Pregnant patient doesn't have immunity to Rubella or Mumps
Give MMR postpartum
If you give it in pregnancy, fetus has a risk of congenital rubella syndrome. It is safe during breastfeeding, though.
134
Congenital Rubella Syndrome
```
Deafness
Cardiac defects
Hepatosplenomegaly
Microcephaly
Cataracts
```
135
Fetal risks in preeclampsia
Abnormal placental development/function:
Uteroplacental insufficiency leads to oligohydramnios & growth restriction/low birth weight, even at full term
136
Contraindications to breastfeeding
```
Active untreated TB
Maternal HIV infection
Herpetic breast lesions
Active varicella infection
Chemotherapy or radiation therapy
Active substance abuse
```
If the infant has galactosemia
137
Sinusoidal fetal heart tracing
Fetal anemia
138
Early decelerations
Shallow decreases in fetal heart rate
Mirror uterine contraction
Response to increased ICP
139
Variable decelerations
Abrupt drops in fetal heart rate
Varying depth and duration
Compression of umbilical cord leads to transient fetal hypertension & parasympathetic bradycardic response
140
Adverse effects of Oxytocin
Hyponatremia (Oxytocin is like Vasopressin)
Hyoptension
Tachysystole (abnormally frequent contractions)
Tetanic contractions
141
Treatment for recurrent variable decelerations
```
Maternal repositioning (left lateral)
Amnioinfusion if that doesn't work
```
142
Follow up after abnormal prenatal screening test
CVS if early (10 - 13 weeks)
| Amniocentesis if late (15 - 20 weeks)
143
Treatment for Gestational Diabetes
Dietary modifications & exercise
Insulin
Glyburide & metformin work too
144
Diabetes drugs not used in pregnancy
Sulfonylureas (chlorpropamide, tolbutamide) cross the placenta
Thiazoledinediones had adverse effects in animal models
145
Management of shoulder dystocia
BE CALM
```
Breathe (do not push)
Elevate legs & flex hips, thighs against abdomen (McRoberts)
Call for help
Apply suprapubic pressure
enLarge vaginal opening with episiotomy
Maneuvers
```
146
Maneuvers for shoulder dystocia
Deliver posterior arm
Rotate posterior shoulder (Woods screw), apply pressure to anterior aspect of posterior shoulder
Adduct posterior fetal shoulder (Rubin), apply pressure to the posterior aspect of the posterior shoulder
Mother on hands & knees, "all fours" (Gaskin)
Replace fetal head into pelvis for cesarean delivery (Zavanelli)
147
Patient presents with false labor at 35 weeks
Reassure, send her home
148
What happens to the uterus if mom goes into hemorrhagic shock?
Blood is shunted AWAY from uterus.
| You may see absence of accelerations on fetal heart tracing.
149
Mom goes into hemorrhagic shock due to abruptio placentae
Fluid resuscitate her with crystalloids
Place her in LLD position
Transfuse her only if she doesn't respond to fluids
150
Why don't we give tocolytics for premature labor >=34 weeks?
Indomethacin - Increased risk of oligohydramnios & closure of the ductus arteriosus
Nifedipine - Increased risk of maternal hypotension/tachycardia
These risks outweigh risks of premature labor
Since we don't give tocolytics at this point, premature labor will likely progress. Give betamethasone & penicillin (if GBS+ or unknown)
151
Vaginal delivery in a singleton breech fetus
Contraindicated. Do a C-section.
152
External cephalic version in active labor
Relatively contraindicated. Don't try it. Do a C-section if the baby is breech.
153
Reactive NST has high negative predictive value to rule out
Fetal acidemia
154
Nonreactive NST
High false positive rate
Low positive predictive value
Cannot rule in fetal acidemia
Evaluate further with BPP or CST
155
Contraindications to Contraction Stress Test (CST)
Contraindications to labor:
Placenta previa
Prior myomectomy
Do a BPP instead, in these patients.
156
BPP score of 0 - 4
Fetal hypoxia due to placental dysfunction
157
Risk factors for placental insufficiency
AMA
Tobacco use
Hypertension
Diabetes
158
Management of Fetal Growth Restriction
Weekly BPPs
Serial umbilical artery Dopplers
Serial growth ultrasounds
159
Recommendations when previa is diagnosed
Pelvic rest
160
In abruptio placentae, the larger the placental detachment, the greater the risk of
DIC (from tissue factor released by decidual bleeding)
Hypovolemic shock
Fetal hypoxia
Preterm delivery
161
Liver pathology in HELLP Syndrome
Centrilobular necrosis
Hematoma formation
Thrombi in portal capillary system
These lead to swelling & distension of Glisson's capsule, resulting in RUQ or epigastric pain.
162
Diagnosis of Antiphospholipid Syndrome
Thrombosis (TIA/Stroke/DVT) & Pregnancy complication (recurrent miscarriage)
PLUS
>=1 of the following:
Anti-cardiolipin Ab
Lupus anticoagulant
Anti-beta2-glycoprotein antibody
163
Treatment for Antiphospholipid Syndrome
Anticoagulation (LMWH in pregnancy, Warfarin long term)
164
Treatment of preterm labor < 34w
```
Tocolytics (Indomethacin, nifedipine)
Corticosteroids (Betamethasone)
Magnesium Sulfate (if <32w) to lower risk of CP
```
165
Magnesium Sulfate (outside of preeclampsia use)
Weak tocolytic
| Used mainly in premature labor for fetal neuroprotection <32 weeks expected to deliver within the next 24 hours
166
Late-term & Postterm Fetal Complications
```
Oligoydramnios
Meconium aspiration
Stillbirth
Macrosomia
Convulsions
```
167
Late-term & Postterm Maternal Complications
Cesarean delivery
Infection
Postpartum hemorrhage
Perineal trauma
168
Late term pregnancy with oligohydramnios but all other fetal testing is normal
Deliver! Oligo suxxxx!
169
Pregnant patients who are underweight or don't gain appropriately are at risk of
Fetal growth restriction
| Preterm delivery
